I have been catching up on my reading, and have only just realized that Sir Derek Wanless, who advised Gordon Brown five years ago how to spend all that extra money on the NHS (our money, may I remind you) and who recently (in a King's Fund report) told us that most of it has been wasted, is also, in his spare time a non-executive director of the Northern Rock bank.
Northern Rock is a salutory reminder that much of NuLabour's reputation for financial prudence is a fig leaf; indeed the party itself is hardly an example of financial prudence. Perhaps we should start calling it NuLabourLite.
Comments please
Saturday 29 September 2007
Thursday 27 September 2007
Our shrinking economy
I am grateful to Iain Dale for the following:
There was one bit of the Brown speech on Monday that caught my eye, but which no one seems to have remarked upon, and it was this sentence:
We should take pride that, under a Labour government, Britain - this small number of people on this small island - is the fifth largest economy in the world.
Didn't we always use to say we were the fourth largest? This happened, of course, under Brown's watch -- in Dec 2005. I think it's strange no one's pointed that particular line out -- seems a strange thing to boast about. 'Under this Labour government, we’ve lost our position as the fourth largest economy in the world…'.
There was one bit of the Brown speech on Monday that caught my eye, but which no one seems to have remarked upon, and it was this sentence:
We should take pride that, under a Labour government, Britain - this small number of people on this small island - is the fifth largest economy in the world.
Didn't we always use to say we were the fourth largest? This happened, of course, under Brown's watch -- in Dec 2005. I think it's strange no one's pointed that particular line out -- seems a strange thing to boast about. 'Under this Labour government, we’ve lost our position as the fourth largest economy in the world…'.
Tuesday 25 September 2007
Waiting for Gordon
The Prime Minister says that he wants the NHS to be his battleground for the next election : good.
Then he can start explaining the wasted billions (as cited by the King's Fund and Sir Derek Wanless), the disaster of PFI, the useless management consultants charging hundreds of millions for very little, the £20billion NHS IT fiasco (for a system that doesn't work).
He can also explain why Choose and Book prevents patients being seen in the hospital of their choice or by the consultant of their choice; he can explain the perverse effect of waiting list targets and the "4 hour rule" which actually costs lives, and the spectacular increase in hospital acquired infections, largely attributable to running hospitals at capacity levels for which they were not designed.
Yes, we are ready for an election; the leaflets are ready for the printers, the badges have been ordered, and the canvassers are ready.
Name the day, Mr Brown.
Then he can start explaining the wasted billions (as cited by the King's Fund and Sir Derek Wanless), the disaster of PFI, the useless management consultants charging hundreds of millions for very little, the £20billion NHS IT fiasco (for a system that doesn't work).
He can also explain why Choose and Book prevents patients being seen in the hospital of their choice or by the consultant of their choice; he can explain the perverse effect of waiting list targets and the "4 hour rule" which actually costs lives, and the spectacular increase in hospital acquired infections, largely attributable to running hospitals at capacity levels for which they were not designed.
Yes, we are ready for an election; the leaflets are ready for the printers, the badges have been ordered, and the canvassers are ready.
Name the day, Mr Brown.
Sunday 23 September 2007
Getting personal
So Gordon Brown tells Andrew Marr on TV today that he wants NHS care to be "more personal" (his words not mine)
So how can that be achieved when our hospital tells GPs that it wants them to no longer refer to consultants by name ( Dear Mr Smith, Dear Dr Spratt, etc) even if that is their, or their patients wish; indeed for some departments such as ENT and orthopoedics it isn't allowed at all anymore.
Meanwhile Brown's health minister Lord Darzi thinks that local hospitals should be shut and replaced by regional superhospitals, where he plans that operations should be done by robots.
More fatuous nonsense from the supreme leader, it seems.
So how can that be achieved when our hospital tells GPs that it wants them to no longer refer to consultants by name ( Dear Mr Smith, Dear Dr Spratt, etc) even if that is their, or their patients wish; indeed for some departments such as ENT and orthopoedics it isn't allowed at all anymore.
Meanwhile Brown's health minister Lord Darzi thinks that local hospitals should be shut and replaced by regional superhospitals, where he plans that operations should be done by robots.
More fatuous nonsense from the supreme leader, it seems.
Friday 21 September 2007
Public opinion
A medical friend has just sent me this:
Yesterday evening I had an insight into the workings of Nulabours "consultation" process on the planned closure of NHS District General Hospitals and replacement with dumbed down polyclinics.
A few weeks ago invitations to attend a public consultation were sent to consultants at our Trust. We were only given one day to reply for the meeting a few days later even though we have to give 6 weeks notice of leave because of "choose and book".
Obviously this meant that most of us could not attend but one consultant did take up the invitation.
The location of the meeting was kept secret until three days before the event and when this consultant was eventually told the location and turned up in Birmingham it turned out that medical staff were outnumbered 2:1 by laypeople specifically chosen by an agency to attend the event. The media were present and had obviously been invited to publicise the event.
The delegates were split up into groups and each allocated an electronic voting device. A "minder" was allocated to each group.
Then the stars of the show arrived: Gordon Brown, Alan Johnson and Ara Darzi.
There followed a rapid succession of questions from the podium on which the delegates were asked to vote. The minder was available to suggest the best answer if there was any doubt.
Strangely, almost all the votes were 2:1 in favour of Nulabour's policy. Even the question: "Would you prefer gynaecological surgery to be carried out in your GP practice even if it meant the closure of your DGH facility?" was answered with 2:1 in favour.
Following the "consultation" the medical delegates were told to leave but the other 2/3 of the audience were kept back and each given an envelope. My colleague was intrigued by this and managed to catch one of the "chosen ones" and ask about the contents. Each envelope contained £75 in cash!
So now the consultation is over and the results indicate there is overwhelming public and doctor support for closing down the DGHs. I can only say that the way the voting was done makes the "Blue Peter" voting fraud seem like, well, "Blue Peter".
So now you know how it works
Yesterday evening I had an insight into the workings of Nulabours "consultation" process on the planned closure of NHS District General Hospitals and replacement with dumbed down polyclinics.
A few weeks ago invitations to attend a public consultation were sent to consultants at our Trust. We were only given one day to reply for the meeting a few days later even though we have to give 6 weeks notice of leave because of "choose and book".
Obviously this meant that most of us could not attend but one consultant did take up the invitation.
The location of the meeting was kept secret until three days before the event and when this consultant was eventually told the location and turned up in Birmingham it turned out that medical staff were outnumbered 2:1 by laypeople specifically chosen by an agency to attend the event. The media were present and had obviously been invited to publicise the event.
The delegates were split up into groups and each allocated an electronic voting device. A "minder" was allocated to each group.
Then the stars of the show arrived: Gordon Brown, Alan Johnson and Ara Darzi.
There followed a rapid succession of questions from the podium on which the delegates were asked to vote. The minder was available to suggest the best answer if there was any doubt.
Strangely, almost all the votes were 2:1 in favour of Nulabour's policy. Even the question: "Would you prefer gynaecological surgery to be carried out in your GP practice even if it meant the closure of your DGH facility?" was answered with 2:1 in favour.
Following the "consultation" the medical delegates were told to leave but the other 2/3 of the audience were kept back and each given an envelope. My colleague was intrigued by this and managed to catch one of the "chosen ones" and ask about the contents. Each envelope contained £75 in cash!
So now the consultation is over and the results indicate there is overwhelming public and doctor support for closing down the DGHs. I can only say that the way the voting was done makes the "Blue Peter" voting fraud seem like, well, "Blue Peter".
So now you know how it works
Tuesday 18 September 2007
Tuesday October 2nd
Don't forget to put this date in your diary; the Save Bedford Hospital party is having a public meeting at Biddenham Village Hall, Nodders Way, Biddenham at 8 p.m
Admission free, all welcome
Come and hear the real story of what is going on.
Admission free, all welcome
Come and hear the real story of what is going on.
Sunday 16 September 2007
Where's the money gone?
www.order-order.com is a website that is not for the fainhearted (see under Guido Fawkes in the "links" column), but today they have produced this masterpiece. I commend it to you:
On 12 September 2007 in a paper submitted to the Treasury Committee by Mervyn King, Governor of the Bank of England, he warned the City: “…the moral hazard inherent in the provision of ex post insurance to institutions that have engaged in risky or reckless lending is no abstract concept”. On September 13, 2007, the Bank of England, pushed by HM Treasury and with the acquiescence of the Financial Services Authority, bailed out mortgage lender Northern Rock. What caused this about turn?
Nobody in the City was surprised by Northern Rock's difficulties, but many were surprised by Mervyn King's overnight U-turn. His stated policy of avoiding moral hazard was prudent and generally accepted in the Square Mile as wise and right. Foolish risk takers should suffer when they get it wrong.
In 1995 Barings collapsed. The Bank of England did not bail it out. Imagine the outrage if a Tory government bailed out the Queen's bankers, "Tory toffs looking after their own pin-striped aristocrats" would have been the charge. Central Banks should only intervene when their is systemic risk to the financial system, not to bail out shareholders when things go wrong. Northern Rock put too many eggs in the mortgage securitisation basket and offered mortgages at slim margins. That strategy is now shown to be risky and unsustainable. So why bail it out?
Northern Rock is not merely the victim of illiquidity in the money markets as Alastair Darling spins, investors knew something was wrong months ago, the share price tumbled long before the sub-prime crisis made the headlines. Nor can you argue that the collapse of the Northern Rock would cause systemic crisis. The mortgages would be administered, the householders would barely notice a change in ownership and it is inconceivable that other banks would suffer contagion.
The economic arguments against a bail out such as this have been impressively made by Mervyn King himself, the special circumstances argument is patently political spin. So isn't it more likely that this is a political decision forced on the Bank of England by Gordon Brown and Alastair Darling to spare their blushes?
Northern Rock is a regional bank from Labour's North-Eastern electoral heartlands. Labour supporting figures are on the board. Sir Derek Wanless, Gordon's favourite banker, chairs the Risk and Audit committee. Sir Iain Gibson sits on both those committees and was appointed by Gordon to the Court of the Bank of England. As far back as the miners strike it has been seen as a "Labour" bank. In the eighties Conservative ministers were furious when striking miners were told not to worry about their mortgages by Northern Rock - removing a pressure on them to return to work. The Labour movement lauded them for it and for their giving of 5% of profits to North Eastern charitable projects.
Guido suspects that the Treasury pressurised Mervyn King, against his better judgement, to bail out Northern Rock for political reasons. Brown's Britain is a bigger version of Northern Rock. Gordon's macro-economic policies are Northern Rock's borrowing policies writ large. Gordon has mortgaged spending through PFI, government debt has ballooned and the consumer economy is floating on debt secured against over-stretched property prices. It can't go on
Boom to Bust : A Political Bail-Out
On 12 September 2007 in a paper submitted to the Treasury Committee by Mervyn King, Governor of the Bank of England, he warned the City: “…the moral hazard inherent in the provision of ex post insurance to institutions that have engaged in risky or reckless lending is no abstract concept”. On September 13, 2007, the Bank of England, pushed by HM Treasury and with the acquiescence of the Financial Services Authority, bailed out mortgage lender Northern Rock. What caused this about turn?Nobody in the City was surprised by Northern Rock's difficulties, but many were surprised by Mervyn King's overnight U-turn. His stated policy of avoiding moral hazard was prudent and generally accepted in the Square Mile as wise and right. Foolish risk takers should suffer when they get it wrong.
In 1995 Barings collapsed. The Bank of England did not bail it out. Imagine the outrage if a Tory government bailed out the Queen's bankers, "Tory toffs looking after their own pin-striped aristocrats" would have been the charge. Central Banks should only intervene when their is systemic risk to the financial system, not to bail out shareholders when things go wrong. Northern Rock put too many eggs in the mortgage securitisation basket and offered mortgages at slim margins. That strategy is now shown to be risky and unsustainable. So why bail it out?
Northern Rock is not merely the victim of illiquidity in the money markets as Alastair Darling spins, investors knew something was wrong months ago, the share price tumbled long before the sub-prime crisis made the headlines. Nor can you argue that the collapse of the Northern Rock would cause systemic crisis. The mortgages would be administered, the householders would barely notice a change in ownership and it is inconceivable that other banks would suffer contagion.
The economic arguments against a bail out such as this have been impressively made by Mervyn King himself, the special circumstances argument is patently political spin. So isn't it more likely that this is a political decision forced on the Bank of England by Gordon Brown and Alastair Darling to spare their blushes?
Northern Rock is a regional bank from Labour's North-Eastern electoral heartlands. Labour supporting figures are on the board. Sir Derek Wanless, Gordon's favourite banker, chairs the Risk and Audit committee. Sir Iain Gibson sits on both those committees and was appointed by Gordon to the Court of the Bank of England. As far back as the miners strike it has been seen as a "Labour" bank. In the eighties Conservative ministers were furious when striking miners were told not to worry about their mortgages by Northern Rock - removing a pressure on them to return to work. The Labour movement lauded them for it and for their giving of 5% of profits to North Eastern charitable projects.Guido suspects that the Treasury pressurised Mervyn King, against his better judgement, to bail out Northern Rock for political reasons. Brown's Britain is a bigger version of Northern Rock. Gordon's macro-economic policies are Northern Rock's borrowing policies writ large. Gordon has mortgaged spending through PFI, government debt has ballooned and the consumer economy is floating on debt secured against over-stretched property prices. It can't go on
Where's Patricia Hewitt?
Former health secretary Patricia Hewitt is an MP for Leicester:
Campaigners are fighting to save the job of health chief Peter Reading who they fear is being made a scapegoat over the collapse of a massive revamp of Leicester's hospitals.
Peter Reading, chief executive of the University Hospitals of Leicester NHS Trust, is said to be on "unavoidable annual leave" and the trust did not know when he was due to return.
Mr Reading failed to appear at a public meeting at the Walkers Stadium on Monday despite it being publicly advertised that he would be there.
He did not attend a trust board meeting on Thursday, September 6 and the board was told he was ill.
Although no-one for the trust will comment further on the current position, patient watchdogs believe he is being forced out because of the collapse of the £711 million Pathway scheme to rebuild Leicester's three hospitals.
The scheme was scrapped in July when costs spiralled to more than £921 million and the trust said it could not afford to go ahead.
Rumours concerning Mr Reading's future have been circulating since the scrapping of Pathway project.
About 500 people are now planning to picket the meeting of the East Midlands Strategic Health Authority, in Nottingham, on October 18.
They will lobby the authority - responsible for overseeing health services in the region - to keep Mr Reading in the job.
Zuffar Haq, chairman of Leicester Patients' Group, is leading the protest.
He said: "I am very concerned that Mr Reading will be made a political scapegoat. It would be a total disaster if, through the interference of Government and strategic health authority, we were to lose one of the best chief executives in the country.
"In the time I have dealt with him, he has been open and honest and does listen to people.
"It will also jeopardise the future development of Leicester's hospitals, which people have been promised for so long."
When asked by the Mercury if Mr Reading had left, a trust spokesman said: "He is on unavoidable annual leave. I don't know when he will be back. He is still chief executive."
The Department of Health said that it has asked the Strategic Health Authority to carry out a review into what went wrong with the Pathway project, a private finance scheme to transform the three sites.
Mr Haq fears hospital development will be further delayed if a new boss is brought in to run Leicester Royal Infirmary, the General and Glenfield hospitals.
Mr Haq said: "The future of Pathway began to look vulnerable when the Treasury called for a review of schemes and put a ceiling on costs.
Campaigners are fighting to save the job of health chief Peter Reading who they fear is being made a scapegoat over the collapse of a massive revamp of Leicester's hospitals.
Peter Reading, chief executive of the University Hospitals of Leicester NHS Trust, is said to be on "unavoidable annual leave" and the trust did not know when he was due to return.
Mr Reading failed to appear at a public meeting at the Walkers Stadium on Monday despite it being publicly advertised that he would be there.
He did not attend a trust board meeting on Thursday, September 6 and the board was told he was ill.
Although no-one for the trust will comment further on the current position, patient watchdogs believe he is being forced out because of the collapse of the £711 million Pathway scheme to rebuild Leicester's three hospitals.
The scheme was scrapped in July when costs spiralled to more than £921 million and the trust said it could not afford to go ahead.
Rumours concerning Mr Reading's future have been circulating since the scrapping of Pathway project.
About 500 people are now planning to picket the meeting of the East Midlands Strategic Health Authority, in Nottingham, on October 18.
They will lobby the authority - responsible for overseeing health services in the region - to keep Mr Reading in the job.
Zuffar Haq, chairman of Leicester Patients' Group, is leading the protest.
He said: "I am very concerned that Mr Reading will be made a political scapegoat. It would be a total disaster if, through the interference of Government and strategic health authority, we were to lose one of the best chief executives in the country.
"In the time I have dealt with him, he has been open and honest and does listen to people.
"It will also jeopardise the future development of Leicester's hospitals, which people have been promised for so long."
When asked by the Mercury if Mr Reading had left, a trust spokesman said: "He is on unavoidable annual leave. I don't know when he will be back. He is still chief executive."
The Department of Health said that it has asked the Strategic Health Authority to carry out a review into what went wrong with the Pathway project, a private finance scheme to transform the three sites.
Mr Haq fears hospital development will be further delayed if a new boss is brought in to run Leicester Royal Infirmary, the General and Glenfield hospitals.
Mr Haq said: "The future of Pathway began to look vulnerable when the Treasury called for a review of schemes and put a ceiling on costs.
Saturday 15 September 2007
2nd October
The Save Bedford Hospital party has organized a public meeting to explain our views on what is going on in the NHS.
Do please come along; it's at Biddenham Village Hall, Nodders Way, Biddenham at 8p.m (Nodders Way is just opposite the Three Tuns pub.
(oh, and by the way, bring your friends)
Do please come along; it's at Biddenham Village Hall, Nodders Way, Biddenham at 8p.m (Nodders Way is just opposite the Three Tuns pub.
(oh, and by the way, bring your friends)
Pouring money down the drain.
How much money is Bedford Hospital spending on its bid to become a Foundation Trust? Newspaper ads ( a four page spread in the Times and Citizen), radio ads, brochures, consultancy fees.
I think that we should be told. Let's face it, it's your money.
I feel a Freedom of Information request coming on.
I think that we should be told. Let's face it, it's your money.
I feel a Freedom of Information request coming on.
Thursday 13 September 2007
Wakey wakey
A key plank of the £6.8bn NHS IT upgrade project in England has come under attack from MPs.
The Health Committee said there was a "worrying lack of progress" and raised concerns about the security of patients' electronic records.
...but why has it taken so long to wake up to what we have been saying for a number of years?
Wednesday 12 September 2007
The King's Fund
Yesterday, the King's Fund, in the form of Sir Derek Wanless, reported on the state of the NHS.
In 300 pages he said what I have been saying for over a year - that all the extra money that has been spent on the NHS has largely been wasted.
Go back over my posts and you will see exactly how - management consultants, IT projects that don't work, targets that have nothing to do with patient care, PFI projects; this list just goes on.
This is exactly why my campaign is so important.
In 300 pages he said what I have been saying for over a year - that all the extra money that has been spent on the NHS has largely been wasted.
Go back over my posts and you will see exactly how - management consultants, IT projects that don't work, targets that have nothing to do with patient care, PFI projects; this list just goes on.
This is exactly why my campaign is so important.
Monday 10 September 2007
At a hospital near you
If you asked a hundred random employees in the NHS what they thought that the NHS needed, I suspect few of them would suggest yet another managerial reorganization. But that is just what we are in the thoes of. Our hospital managers are hell bent on us applying for "Foundation Status"; from their point of view it will no doubt be an opportunity for new job titles and pay rises. From the Department of Health's point of view it is a great opportunity to devolve problems ("not our fault, the're an independent foundation"). From the point of view of us poor foot soldiers the benefits are far from clear.
One of the hoops that they have to go though is to prove that they have local support and to sign up 4000 locals as "Foundation Trust Members". This is a bit tricky, so the way that our managers have done this is to announce that all employees (even if, as in the case of my clinical assistant you only work for the hospital three hours a week) are automatically deemed to be in favour of the applcation and to be "members". If you want to opt out of this you have to give the management your name and details of where in the hospital you work - which few are hardly likely to do when only a few months ago one in seven of the hospital's employees were on redundancy warnings. No such thing as a secret ballot.
So there you have the new democracy: you're automatically in favour, whether you vote for Foundation Trust status or now, unless you give then your name and put your head on the chopping block. Even the Iraqis had something closer to a democratic election.
One of the hoops that they have to go though is to prove that they have local support and to sign up 4000 locals as "Foundation Trust Members". This is a bit tricky, so the way that our managers have done this is to announce that all employees (even if, as in the case of my clinical assistant you only work for the hospital three hours a week) are automatically deemed to be in favour of the applcation and to be "members". If you want to opt out of this you have to give the management your name and details of where in the hospital you work - which few are hardly likely to do when only a few months ago one in seven of the hospital's employees were on redundancy warnings. No such thing as a secret ballot.
So there you have the new democracy: you're automatically in favour, whether you vote for Foundation Trust status or now, unless you give then your name and put your head on the chopping block. Even the Iraqis had something closer to a democratic election.
Dr Rant is upset
The BBC seem to have upset Dr Rant!
Apparently, Whatsisface, you know the new Secretary of State for Health was on Radio 4's 'Today' program this morning. He agreed with John Humphrey's contention that:"GPs have too much of a 9 to 5 mentality."Sorry Humph, but I missed your incisive questioning because I was at work before 8am. I'll also still be at work after Radio 4's other paroxysm of half-arsed, sanctimonious pomposity, 'PM' has finished, and I do this 5 times a week.Well, in Dr Rant's opinion, John Humphreys has got too much of a '6am to 9am every other day' mentality. It appears that he only works 9 hours a week, yet still earns more than what he considers to be an outrageous amount for a mere GP to earn.The lazy, workshy, money-grabbing, sheep-shagging twat!
Apparently, Whatsisface, you know the new Secretary of State for Health was on Radio 4's 'Today' program this morning. He agreed with John Humphrey's contention that:"GPs have too much of a 9 to 5 mentality."Sorry Humph, but I missed your incisive questioning because I was at work before 8am. I'll also still be at work after Radio 4's other paroxysm of half-arsed, sanctimonious pomposity, 'PM' has finished, and I do this 5 times a week.Well, in Dr Rant's opinion, John Humphreys has got too much of a '6am to 9am every other day' mentality. It appears that he only works 9 hours a week, yet still earns more than what he considers to be an outrageous amount for a mere GP to earn.The lazy, workshy, money-grabbing, sheep-shagging twat!
Sunday 9 September 2007
Is the worm turning?
Patients' needs have been ignored under Labour's reform of the NHS, the man who was tasked with protecting their rights believes.
GP care has taken a "step backwards", while endlessly reorganising the health service has been a "waste of time and money", according to Harry Cayton, until last month the NHS "patients' tsar". He also accuses the British Medical Association of being against patient choice and says that GPs will change only if they are paid to. Mr Cayton revealed that he resisted pressure from ministers to produce a report supporting plans to reorganise and close hospitals because he could find no evidence that the proposals were driven by the needs of the public. He also said the job, which he held for five years, was hindered by a slew of policies that worsened the quality of care. |
Friday 7 September 2007
MMC again
A terrible way to treat our doctors
By Martin Wolf
Published: September 7 2007 03:00 Last updated: September 7 2007 03:00
"Modernising Medical Careers" is a suitably Orwellian name for a Stalinist new system for training doctors in the National Health Service.
The phrase is a perfect example of newspeak. To oppose a "modern" system is to be a conservative, if
not a reactionary. Yet, like all systems of centralised planning,
this one has proved inefficient, inflexible and inhumane. It is an object lesson in the dangers of the ever-growing capture of hitherto autonomous professions and institutions by the state.
Like most outsiders (and many insiders), I find it impossible to understand precisely what has happened, but having a daughter-in-law at the sharp end
has helped. The outlines at least are clear. They also offer a classic example of how a government-run monopoly behaves.
What, then, lay behind the fiasco that Modernising Medical Careers
has become? There appear to be
three causes.
First, the department resolved on seizing control over medical training from the professional colleges and consultants, who happen to know what doctors can (and should be able to) do.
Second, the bureaucrats made a mess of manpower planning: in England, for example, 29,200 doctors have been competing for the 15,600 training places they arbitrarily decided to create.
Third, they chose this moment of upheaval to introduce an inflexible and characteristically defective computerised system (the Medical Training and Application System) to allocate doctors across the country.
As always, reasons existed for the shift to central planning: critics complained that the traditional apprentice system was riddled with favouritism; and the European Union's working time directive sharply cut hours for junior doctors, which not only necessitated a greater number of them, but also reduced the experience each would gain from a given period of training.
Some reform was presumably necessary. But this one is an object lesson in what happens when the government introduces a "big bang" shift to a centralised, computer-driven system. A bureaucratic monster replaced what had been a moderately flexible, albeit imperfect, system.
In the old system hospitals hired senior house officers; now they are sent them like a parcel of slaves. In the old system, if doctors did not get a job first time they could keep on applying; in the new system, they were to be given just one chance a year. In the old system, if they made a wrong choice it was relatively easy to change; in the new system, doctors must decide early and are then stuck with the consequences. In the old system, hospitals could change the mix of junior doctors relatively easily; in the new system, nobody knows what flexibility will exist.
Allocations to training posts are within huge geographical areas. But doctors are dispatched, like so much meat, to one hospital. Do they live hours away? That is tough luck. Do they have a partner, or even children? That is just tougher luck. Do they wish to switch hospital or sub-speciality? They must be joking. Do they wish to know the terms and conditions of their employment before arriving? They must really
be joking.
To put the point bluntly, these highly trained professionals, on
whom you may depend for your
lives or those of your loved ones, are being treated with contempt. Do you want to be looked after by someone
so treated?
To make the computerisation manageable, the doctors were allowed only very limited choices - far too few to eliminate random factors. As the chaos mounted, people were offered just one interview each.
The result was that those most likely to fail to get a job were the best, because they made the most desirable options their first choice. To make the computerised system "fair", much of the detail of people's careers and the detailed knowledge of those they worked for were also eliminated.
Centrally planned systems always eliminate latent knowledge, ignore human motivation and destroy flexibility. It was predictable that this Gosplan for the training of doctors would end up just as it has. It could not do anything else. This is a superb example of how the combination of centralisation of power with a belief in rationalistic planning works in the real world.
No less predictable is the fact that those who made these blunders are still in place. One might have expected resignations, starting with Sir Liam Donaldson, chief medical officer. But bureaucrats are far too grand to be held accountable. It is doctors whose lives are disposable. Who cares that they have devoted up to a decade to the acquisition of knowledge and experience? Who cares that patients will be worse served? What matters is that the Department of Health is firmly in charge.
So is the NHS suffering from an excess of free market zeal, as many on the left believe? Hardly. Where it matters, the planners are in charge. As always, they are making a big mess and, as almost always, they look likely to get away with it unscathed.
Copyright The Financial Times Limited 2007
By Martin Wolf
Published: September 7 2007 03:00 Last updated: September 7 2007 03:00
"Modernising Medical Careers" is a suitably Orwellian name for a Stalinist new system for training doctors in the National Health Service.
The phrase is a perfect example of newspeak. To oppose a "modern" system is to be a conservative, if
not a reactionary. Yet, like all systems of centralised planning,
this one has proved inefficient, inflexible and inhumane. It is an object lesson in the dangers of the ever-growing capture of hitherto autonomous professions and institutions by the state.
Like most outsiders (and many insiders), I find it impossible to understand precisely what has happened, but having a daughter-in-law at the sharp end
has helped. The outlines at least are clear. They also offer a classic example of how a government-run monopoly behaves.
What, then, lay behind the fiasco that Modernising Medical Careers
has become? There appear to be
three causes.
First, the department resolved on seizing control over medical training from the professional colleges and consultants, who happen to know what doctors can (and should be able to) do.
Second, the bureaucrats made a mess of manpower planning: in England, for example, 29,200 doctors have been competing for the 15,600 training places they arbitrarily decided to create.
Third, they chose this moment of upheaval to introduce an inflexible and characteristically defective computerised system (the Medical Training and Application System) to allocate doctors across the country.
As always, reasons existed for the shift to central planning: critics complained that the traditional apprentice system was riddled with favouritism; and the European Union's working time directive sharply cut hours for junior doctors, which not only necessitated a greater number of them, but also reduced the experience each would gain from a given period of training.
Some reform was presumably necessary. But this one is an object lesson in what happens when the government introduces a "big bang" shift to a centralised, computer-driven system. A bureaucratic monster replaced what had been a moderately flexible, albeit imperfect, system.
In the old system hospitals hired senior house officers; now they are sent them like a parcel of slaves. In the old system, if doctors did not get a job first time they could keep on applying; in the new system, they were to be given just one chance a year. In the old system, if they made a wrong choice it was relatively easy to change; in the new system, doctors must decide early and are then stuck with the consequences. In the old system, hospitals could change the mix of junior doctors relatively easily; in the new system, nobody knows what flexibility will exist.
Allocations to training posts are within huge geographical areas. But doctors are dispatched, like so much meat, to one hospital. Do they live hours away? That is tough luck. Do they have a partner, or even children? That is just tougher luck. Do they wish to switch hospital or sub-speciality? They must be joking. Do they wish to know the terms and conditions of their employment before arriving? They must really
be joking.
To put the point bluntly, these highly trained professionals, on
whom you may depend for your
lives or those of your loved ones, are being treated with contempt. Do you want to be looked after by someone
so treated?
To make the computerisation manageable, the doctors were allowed only very limited choices - far too few to eliminate random factors. As the chaos mounted, people were offered just one interview each.
The result was that those most likely to fail to get a job were the best, because they made the most desirable options their first choice. To make the computerised system "fair", much of the detail of people's careers and the detailed knowledge of those they worked for were also eliminated.
Centrally planned systems always eliminate latent knowledge, ignore human motivation and destroy flexibility. It was predictable that this Gosplan for the training of doctors would end up just as it has. It could not do anything else. This is a superb example of how the combination of centralisation of power with a belief in rationalistic planning works in the real world.
No less predictable is the fact that those who made these blunders are still in place. One might have expected resignations, starting with Sir Liam Donaldson, chief medical officer. But bureaucrats are far too grand to be held accountable. It is doctors whose lives are disposable. Who cares that they have devoted up to a decade to the acquisition of knowledge and experience? Who cares that patients will be worse served? What matters is that the Department of Health is firmly in charge.
So is the NHS suffering from an excess of free market zeal, as many on the left believe? Hardly. Where it matters, the planners are in charge. As always, they are making a big mess and, as almost always, they look likely to get away with it unscathed.
Copyright The Financial Times Limited 2007
Thursday 6 September 2007
Thank you
Thanks to Boleyn Press for the excellent campaign leaflets which they have printed for me.
Financial prudence?
The government frequently crows about financial prudence: so how does it explain this?
The handling of a £1.5bn computerised farm payments scheme by two senior civil servants is condemned by MPs today as "a masterclass in bad decision-making" which could land taxpayers with a £500m extra bill. A highly critical report from the Commons public accounts committee accuses Sir Brian Bender, then permanent secretary at the Department for Environment, Food and Rural Affairs, of being "largely responsible" for the fiasco, which left tens of thousands of farmers without any cash from the European Union.
The fact is that that the government is totally profligate with your money. And don't forget it is your money (government's don't actually have any money of their own).
The handling of a £1.5bn computerised farm payments scheme by two senior civil servants is condemned by MPs today as "a masterclass in bad decision-making" which could land taxpayers with a £500m extra bill. A highly critical report from the Commons public accounts committee accuses Sir Brian Bender, then permanent secretary at the Department for Environment, Food and Rural Affairs, of being "largely responsible" for the fiasco, which left tens of thousands of farmers without any cash from the European Union.
The fact is that that the government is totally profligate with your money. And don't forget it is your money (government's don't actually have any money of their own).
Wednesday 5 September 2007
Is this fair?
A British member of the European parliament will continue to get £75,000 a year in salary and expenses despite being jailed yesterday for swindling £65,500 from the taxpayer in a five-year benefits fraud.
No wonder politicians are held is such contempt
Ashley Mote was elected in 2004 as an MEP for the UK Independence party, but was thrown out of Ukip after the fraud charges. He sat as an independent and joined a far-right bloc. Mote, who represented south-east England, was jailed for nine months. He would have been expelled from the European parliament had he been jailed for 12 months or more.
No wonder politicians are held is such contempt
Tuesday 4 September 2007
Public debate
I believe that politicians (and intending politicians) should be able and willing to answer challenging questions. But this is clearly not the prime Minister's view.
This conversation took place at today's Prime Ministerial press briefing:
David Grossman (Newsnight) : Prime Minister, on Breakfast News in 1987 you said that Margaret Thatcher should accept the then Leader of the Opposition's invitation to debate him live on television. You said it was only right for the British people to see the two protaginists debate each other. However, today you ruled out such a debate. What has changed in the intervening period?
Gordon Brown: Well, er, you know, er... blah....blah...not a presidential system....blah... play for time...plenty of opportunity to question me in the House of Commons...blah...not a presidential system....blah...ok?
This conversation took place at today's Prime Ministerial press briefing:
David Grossman (Newsnight) : Prime Minister, on Breakfast News in 1987 you said that Margaret Thatcher should accept the then Leader of the Opposition's invitation to debate him live on television. You said it was only right for the British people to see the two protaginists debate each other. However, today you ruled out such a debate. What has changed in the intervening period?
Gordon Brown: Well, er, you know, er... blah....blah...not a presidential system....blah... play for time...plenty of opportunity to question me in the House of Commons...blah...not a presidential system....blah...ok?
management beanfeast
As far as many of us can work out, PFI is a system designed by politicians to make their friends lots of money, and to make the rest of us pay.
This is an example (from the Guardian) of how it works in Coventry:
In Coventry it had been planned to refurbish two hospitals at a cost of £30m. But analysts realised that business would not be interested. The scheme was too small, and there was no scope for the financial innovation that could produce serious profits. As a confidential report by the local health authority showed in 1998, the health service redesigned its scheme to make it more attractive to private capital. Instead of refurbishing the two existing hospitals, it would ask private business to knock them down and build a new one - the University hospital. This would cost not £30m but £174m. The health experts who wrote the confidential report predicted that in order to find this money, the hospital trust would have to cut both beds and services. They have just been proved right.
Did I say £174m? I beg your pardon. By January 2002 the price had risen to £290m. A month later it reached £311m. By the end of that year it had grown to £330m. In 2003 it was estimated at £370m. In March 2007, the Birmingham Post reported that the final cost was £410m. This year the hospital trust must find £56m, covering repayments and service fees, to hand to the private consortium. The annual cost will rise in line with the retail price index for 30 years.
It is now pretty obvious that this fee is unpayable, if the hospital is to maintain a proper standard of care. Over the past few days the hospital trust has announced a £30m hole in its budget. Around £10m of the necessary cuts could be found by making staff redundant: it will lose perhaps 200 people, possibly 375. It will also rely on "revenue generating activities". These include charging people £3 for dropping their sick relatives outside the hospital, and £10 for parking there, while cancelling the free parking scheme for disabled people. As the new hospital is on the edge of the city (against the wishes of 160,000 people who signed the Socialist party's petition to have it built in the centre), which means that it is hard to reach without a car, this is an effective way of raising money. But it casts doubt on the government's claim that the NHS remains free at the point of use.
The hospital trust's press officer told me that this cost-cutting is a unique event: "We have always balanced our books up to this year." But in 2005 - the year in which the PFI payments began - a leaked memo revealed that the trust was anticipating a deficit of £13m by the end of the financial year, and "drastic measures" were required to plug the gap. These included the closure of one ward, the removal of eight beds from another, limiting the opening hours of the surgical assessment unit and the "rationalisation of certain posts": which meant, eventually, cutting 116 jobs.
In 2006 the local newspaper reported a shortfall of £29m. This was met partly by freezing the recruitment of district nurses. In January this year, the hospital announced that it was closing another ward, just six months after it had opened. Yet another ward - where people with acute conditions such as pneumonia and strokes were treated - was closed in June. The impact of these cuts is already being felt: three months ago the new hospital found itself in the bottom 10 in the national league table for waiting times. Where will the money come from over the rest of the 30-year PFI contract?
There is one set of costs the hospital cannot cut: the money it must pay every year to the private financiers. In September 1997 the government declared that these payments would be legally guaranteed: beds, doctors, nurses and managers could be sacrificed, but not the annual donation to the Fat Cats Protection League. The great free market experiment looks more like a corporate welfare scheme.
This is an example (from the Guardian) of how it works in Coventry:
In Coventry it had been planned to refurbish two hospitals at a cost of £30m. But analysts realised that business would not be interested. The scheme was too small, and there was no scope for the financial innovation that could produce serious profits. As a confidential report by the local health authority showed in 1998, the health service redesigned its scheme to make it more attractive to private capital. Instead of refurbishing the two existing hospitals, it would ask private business to knock them down and build a new one - the University hospital. This would cost not £30m but £174m. The health experts who wrote the confidential report predicted that in order to find this money, the hospital trust would have to cut both beds and services. They have just been proved right.
Did I say £174m? I beg your pardon. By January 2002 the price had risen to £290m. A month later it reached £311m. By the end of that year it had grown to £330m. In 2003 it was estimated at £370m. In March 2007, the Birmingham Post reported that the final cost was £410m. This year the hospital trust must find £56m, covering repayments and service fees, to hand to the private consortium. The annual cost will rise in line with the retail price index for 30 years.
It is now pretty obvious that this fee is unpayable, if the hospital is to maintain a proper standard of care. Over the past few days the hospital trust has announced a £30m hole in its budget. Around £10m of the necessary cuts could be found by making staff redundant: it will lose perhaps 200 people, possibly 375. It will also rely on "revenue generating activities". These include charging people £3 for dropping their sick relatives outside the hospital, and £10 for parking there, while cancelling the free parking scheme for disabled people. As the new hospital is on the edge of the city (against the wishes of 160,000 people who signed the Socialist party's petition to have it built in the centre), which means that it is hard to reach without a car, this is an effective way of raising money. But it casts doubt on the government's claim that the NHS remains free at the point of use.
The hospital trust's press officer told me that this cost-cutting is a unique event: "We have always balanced our books up to this year." But in 2005 - the year in which the PFI payments began - a leaked memo revealed that the trust was anticipating a deficit of £13m by the end of the financial year, and "drastic measures" were required to plug the gap. These included the closure of one ward, the removal of eight beds from another, limiting the opening hours of the surgical assessment unit and the "rationalisation of certain posts": which meant, eventually, cutting 116 jobs.
In 2006 the local newspaper reported a shortfall of £29m. This was met partly by freezing the recruitment of district nurses. In January this year, the hospital announced that it was closing another ward, just six months after it had opened. Yet another ward - where people with acute conditions such as pneumonia and strokes were treated - was closed in June. The impact of these cuts is already being felt: three months ago the new hospital found itself in the bottom 10 in the national league table for waiting times. Where will the money come from over the rest of the 30-year PFI contract?
There is one set of costs the hospital cannot cut: the money it must pay every year to the private financiers. In September 1997 the government declared that these payments would be legally guaranteed: beds, doctors, nurses and managers could be sacrificed, but not the annual donation to the Fat Cats Protection League. The great free market experiment looks more like a corporate welfare scheme.
Sunday 2 September 2007
From the Financial Times
Like a beast put into our cage'
By Margaret McCartney
You might have heard of the strange case of Creswell, in north-east Derbyshire. Last year, the general practice there went out to tender, a
government initiative designed to increase competition among potential healthcare providers. The contract for running Creswell's general practice was won by the multinational "diversified health and wellbeing company" UnitedHealth Europe.
However, a local woman named Pam Smith challenged this decision and, after initially losing her case at the High Court, successfully applied to the Appeal Court, arguing that the community had not been adequately consulted
in the tender process.
The Department of Health then intervened, saying that there was no need to consult the community. So after the appeal was upheld in August 2006, the whole thing went out to tender again and, in February this year, was won by another private company that provides healthcare, Chilvers McCrea.
Seven months on, Chilvers McCrea has yet to sign the contract and yet to start work. It was due to sign the contract on June 4 but, three days
beforehand, was advised that it had no lease for the building. While all this has been going on, the Creswell practice has been run by the Derbyshire Primary Care Trust, surviving through a mixture of locums.
The minutes from a meeting in July of the primary care trust, which was responsible for holding the tender process, note that "this tender has proved a costly exercise" and that Chilvers McCrea "are actively recruiting
permanent medical staff, though have expressed concern that this is proving difficult".
Chilvers McCrea has now recruited permanent staff. But instability appears to be an inevitable part of such tendering processes, which seem to place remarkably little emphasis on who will be doing the work. To illustrate:
companies applying to tender to Creswell were required to provide documentation in support of their applications, including cash flow
projections; but what seems not to have been asked, in the first round at least, is which people would actually be providing the frontline care.
Am I alone in thinking that if I was running this process I'd want, as a matter of priority, to know who was actually going to be seeing patients? I would want to know the qualifications of the staff, their range of abilities and experiences. I might even want to meet and interview them. I might also
want to know about the location, the building and transport links but, surely, the quality of the frontline medical care would trump just about everything else.
The irony is that within Creswell there were a number of local GPs who wanted to provide medical services to the community, including a group of locums prepared to become permanent. Dr Elizabeth Barrett is a GP well known
within the area. She had the support of her parish council to the extent that they were willing to give her practice free land for a new
purpose-designed building. This was not enough for her to succeed in the tender process.
Should competition apply to providing quality, cost-effective healthcare? Continuity of care is one of the markers of good, safe and satisfying
patient care. The fragmentation of a coherent, doctor-led general practice service is therefore an enormous change in the way we get healthcare and one that seems to have escaped public scrutiny.
Those in favour of privatised contractors taking over primary care, point out that GPs are for the most part self-employed contractors to the NHS. It is true that some GPs are - or become - self-interested but it is also true that most still care about professionalism and patient satisfaction and work as a stable cottage industry, with little ambition to conquer neighbouring practices. When I talked to Dr Barrett, she told me: "In general practice we
have probably become complacent and the private sector has been put like a beast in our cage. We need to be committed and responsive to the customer."
For Dr Barrett, "the choice is of a market-based system or a community-oriented collaborative process. Do we really want general practice
run like a supermarket chain or a mechanistic production line? Primary care is far more than that," she says.
Let's agree that general practice has to be innovative and responsive to the needs of patients. The question then is how we want to do this. If we model healthcare on businesses, we may be able to count and shift units - or
patients - very well. However, if this is all we are willing to pay for, we haven't begun to think about what the cost to the patients might be.
Margaret McCartney is a GP in Glasgow.
By Margaret McCartney
You might have heard of the strange case of Creswell, in north-east Derbyshire. Last year, the general practice there went out to tender, a
government initiative designed to increase competition among potential healthcare providers. The contract for running Creswell's general practice was won by the multinational "diversified health and wellbeing company" UnitedHealth Europe.
However, a local woman named Pam Smith challenged this decision and, after initially losing her case at the High Court, successfully applied to the Appeal Court, arguing that the community had not been adequately consulted
in the tender process.
The Department of Health then intervened, saying that there was no need to consult the community. So after the appeal was upheld in August 2006, the whole thing went out to tender again and, in February this year, was won by another private company that provides healthcare, Chilvers McCrea.
Seven months on, Chilvers McCrea has yet to sign the contract and yet to start work. It was due to sign the contract on June 4 but, three days
beforehand, was advised that it had no lease for the building. While all this has been going on, the Creswell practice has been run by the Derbyshire Primary Care Trust, surviving through a mixture of locums.
The minutes from a meeting in July of the primary care trust, which was responsible for holding the tender process, note that "this tender has proved a costly exercise" and that Chilvers McCrea "are actively recruiting
permanent medical staff, though have expressed concern that this is proving difficult".
Chilvers McCrea has now recruited permanent staff. But instability appears to be an inevitable part of such tendering processes, which seem to place remarkably little emphasis on who will be doing the work. To illustrate:
companies applying to tender to Creswell were required to provide documentation in support of their applications, including cash flow
projections; but what seems not to have been asked, in the first round at least, is which people would actually be providing the frontline care.
Am I alone in thinking that if I was running this process I'd want, as a matter of priority, to know who was actually going to be seeing patients? I would want to know the qualifications of the staff, their range of abilities and experiences. I might even want to meet and interview them. I might also
want to know about the location, the building and transport links but, surely, the quality of the frontline medical care would trump just about everything else.
The irony is that within Creswell there were a number of local GPs who wanted to provide medical services to the community, including a group of locums prepared to become permanent. Dr Elizabeth Barrett is a GP well known
within the area. She had the support of her parish council to the extent that they were willing to give her practice free land for a new
purpose-designed building. This was not enough for her to succeed in the tender process.
Should competition apply to providing quality, cost-effective healthcare? Continuity of care is one of the markers of good, safe and satisfying
patient care. The fragmentation of a coherent, doctor-led general practice service is therefore an enormous change in the way we get healthcare and one that seems to have escaped public scrutiny.
Those in favour of privatised contractors taking over primary care, point out that GPs are for the most part self-employed contractors to the NHS. It is true that some GPs are - or become - self-interested but it is also true that most still care about professionalism and patient satisfaction and work as a stable cottage industry, with little ambition to conquer neighbouring practices. When I talked to Dr Barrett, she told me: "In general practice we
have probably become complacent and the private sector has been put like a beast in our cage. We need to be committed and responsive to the customer."
For Dr Barrett, "the choice is of a market-based system or a community-oriented collaborative process. Do we really want general practice
run like a supermarket chain or a mechanistic production line? Primary care is far more than that," she says.
Let's agree that general practice has to be innovative and responsive to the needs of patients. The question then is how we want to do this. If we model healthcare on businesses, we may be able to count and shift units - or
patients - very well. However, if this is all we are willing to pay for, we haven't begun to think about what the cost to the patients might be.
Margaret McCartney is a GP in Glasgow.
Saturday 1 September 2007
How safe is our banking system?
Gordon Brown claims much of the credit for the soundness of our economy. But how secure is the whole banking system when you read about this sort of thing:
Barclays says that a "technical breakdown" in the UK's clearing system forced it to borrow £1.6bn from the Bank of England.
Barclays says that a "technical breakdown" in the UK's clearing system forced it to borrow £1.6bn from the Bank of England.
It is the second time this month that the bank has tapped into the central bank's emergency credit line, sparking fears it is facing a cash crisis. (source: BBC 31st August 2007)
Does this matter to you and me? well I think that it does, because if the economy isn't sound, then there just won't be the resources available for the NHS (or other vital parts of the public sector - education, roads, police,etc)
Perhaps Mr Brown isn't quite as clever as he thinks he is.
Subscribe to:
Posts (Atom)